April 16, 2012 -- It was a typical, relaxed Saturday in the Grant home. Jesse, 12, was playing video games with his 10-year-old brother and his cousin.

But while waiting his turn, Jesse ducked into his bedroom, closed the door, and accidentally hanged himself with a computer cord while playing a solitary "choking game."

That was seven years ago this week, and thanks to Jesse's mother, Sharon, and other victims' parents, the so-called game has garnered increasing attention from the media and academia.

A new study, from a survey of nearly 5,400 Oregon 8th-graders, shows that 6.1% said they'd tried the
choking game at least once, which is consistent with previous studies from other states and Canada. Of those who reported participating in the choking game, 64% said they had done it more than once, and 26.6% reported doing it more than five times.

The game goes by many names -- "Knock Out," "Space Monkey," "Flatlining," or "The
Fainting Game" to name a few -- according to the new report. Players apply pressure to the main artery in their neck, with a belt, towel, rope, or other item, to limit oxygen and blood flow to the brain. Their goal: a "high" once the pressure is released and blood and oxygen rush back to the brain.

Deaths Probably Underreported

Between 1995 and 2007, there were 82 U.S. deaths attributed to the choking game in children 6 to 19, according to the CDC. However, the scientists write, that's likely an underestimation because it includes only deaths covered by the media. And, says researcher Robert Nystrom, adolescent health manager at the Oregon Public Health Division, some deaths from the choking game end up being classified as suicides.

Kids have been playing the choking game for at least half a century, but YouTube and social media have made it more pervasive than ever, Nystrom says.

And if children have tried it once, they're likely to try it again, the Oregon survey shows. Two-thirds of the kids who said they'd ever tried it had tried it more than once, and more than a quarter said they'd tried it more than five times.

Getting the Word Out

"The public health challenge right now is getting awareness and education to adults and [health care] providers," Nystrom says. A 2009 report noted that up to a third of pediatricians had never heard of the choking game, he says.

"Those that had [heard of it] had limited ability to identify signs and symptoms." Assessing young patients' risk of dangerous behaviors such as the choking game needs to be a part of teen doctor visits, Nystrom says.

Some children who engage in the behavior might be overlooked because of myths surrounding it, he says. One common belief is that boys are much more likely to play the choking game than girls, but his study found the sexes were pretty even.

Nystrom's team also found that sexual activity and substance use were significantly associated with choking game participation for boys and girls.

Thomas Andrew, MD, New Hampshire's chief medical examiner, called Nystrom's study "very important," because "it gives us a better handle" on how many young people engage in the choking game.

"Now," Andrew says, "the question still before us is whether or not there are ways to identify that potential six percent" before they try it. Those teens could then be the focus of prevention strategies effective against high-risk behaviors, he says.

Instead of treating the choking game like some forbidden fruit, increasing its appeal, adults need to emphasize its health dangers, Andrew says.

"The thing I would say first for parents is don't be afraid to talk to your kids, and definitely listen to them," Nystrom says. Watch for warning signs, he says, such as talk about the game, attempts to hide marks on the neck, or ropes and the like tied on doorknobs.

Sharon Grant says her son, Jesse, told her he learned the choking game at summer camp and viewed it as just another type of camp hijinks, like short-sheeting a bunkmate's bed. She recognized it as dangerous but says she wasn't worried about her son because he was an "A" student and an athlete. It wasn't until three months after Jesse's death, Grant says, that she learned he had taught his younger brother how to play the game.

To prevent more deaths, Grant, who lives near the town of Barrie in southern Ontario, founded an organization called GASP, for "Games Adolescents Shouldn't Play." The group's goal, she says, is to educate parents, teachers, and other adults who come in contact with young people that the choking game is just as risky as drug and alcohol abuse.

The new study appears online in Pediatrics.

SOURCES: Sharon Grant, executive director of GASP. Robert Nystrom, adolescent health manager at the Oregon Public Health Division. Thomas Andrew, MD, chief medical examiner for the state of New Hampshire.